Challenges

Between 1995 and 2015, the number of people practising open defecation in São Tomé and Principe decreased by 20 per cent. However, 54 per cent still used open spaces for defecation (Joint Monitoring Programme for Water Supply, Sanitation and Hygiene, 2015). To reduce open defecation by increasing access to and use of latrines, the United Nations Children’s Fund (UNICEF) and the country’s Ministry of Infrastructure and Natural Resources wanted to draw on lessons learned from another country initiative that had a solid evidence-based experience in this area. They chose Guinea-Bissau because it had reduced open defecation from 31 to 18 per cent from 2006 to 2014. Much of this success is credited to UNICEF Guinea-Bissau and its partners, which have been using the community-led total sanitation (CLTS) approach to reduce open defecation in rural areas since 2011. The CLTS approach is rooted in community demand and leadership, focusing on behaviour and social change, and encouraging local innovation to end open defecation.

Toward a Solution

To address the above challenge, cooperation between Guinea-Bissau and São Tomé and Principe was established in four distinct phases: learning from evidence; diagnosis; planning; and, pilot actions.The first phase included a field visit to Guinea-Bissau by two São Tomé and Principe government officers. During the visit they exchanged information on the role and responsibilities of the main stakeholders in Guinea-Bissau and São Tomé and Principe, such as government officers and implementing partners. São Tomé and Principe officers also visited communities where the CLTS approach had been implemented. Here, they learned about the innovative use of smartphones in Guinea-Bissau to monitor CLTS implementation and communities’ progress to end open defecation. They also held discussions with the communities, facilitators and local authorities to understand the different phases of the implementation process.

The field visit highlighted that São Tomé and Principe needed tailored technical assistance on the second phase (diagnosis), so UNICEF São Tomé and Principe received in-country technical assistance from UNICEF Guinea-Bissau to develop an Action Plan for CLTS Implementation. The supporting officer from Guinea-Bissau also participated in a conference on sanitation in May 2017 in São Tomé and Principe. He shared the CLTS approach in Guinea-Bissau and the country’s progress and achievements. All the main stakeholders in the water and sanitation sector, including local government officers, participated in the conference. This enabled a detailed discussion on how Guinea-Bissau’s experience can be applied to the needs of São Tomé and Principe.

As part of the third phase (planning), bilateral meetings were held with several government officials from the Ministries of Infrastructure and Natural Resources, Health and Education, the World Health Organization (WHO), African Development Bank and civil society stakeholders (non-governmental organizations and community-based organizations) to discuss opportunities available to successfully implement the rural sanitation programme. These meetings also provided ideas on how these opportunities could be integrated into the action plan for CLTS implementation. After the action plan was finalized with these inputs, a final meeting was held with government officers and partners to present the draft action plan, which was subsequently submitted to the Minister of Infrastructure and Natural Resources for official approval.

The fourth phase began in early 2018 with a CLTS training for all partners, including the central government team from the Sanitation Department and the selected non- governmental organizations (NGOs) or community- based organizations (CBOs) as implementing partners. This will be followed by the launch of a pilot project in one district of São Tomé and Principe.

During the project roll-out, the São Tomé and Principe Government created a task force to advise on the choice of the pilot communities and training of the selected NGOs/CBOs to initiate CLTS implementation. The success of the pilot will determine the potential for scale-up of the programme nationwide. In addition, it will be important to confirm the Government’s buy-in at each stage of implementation to ensure the project’s successful scale-up and sustainability.

Furthermore, the cooperation of São Tomé and Guinea-Bissau to promote CLTS by sharing lessons and solutions is a pioneering initiative, since the focus within the CLTS context is generally on building interventions based on local specifics. Finally, implementing the CLTS approach does not require communities to contribute financial resources, so it can easily be replicated in the most disadvantaged communities. For this reason, CLTS can also be used as an entry point for many other issues, such as safe sanitation in community schools, water safety planning, nutritional surveillance, and planning and implementing the CLTS approach, based on the Guinea-Bissau experience.